Roy Ellis Clark, M.S., CCC-A

Primary specialty

AudiologistTaxonomy code 231H00000X

License

23002042 Issued in IN

Practice address

2345 Northpark Dr
Columbus, IN 47203-4473

Phone

(812) 669-1490

Fax

(812) 669-1491

NPI assigned

Apr 22, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Specialty

Qualified Audiologist

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Otolaryngology Specialty Care LLCGroup PAC ID 2264697630, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/26285/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Otolaryngology Specialty Care, LLC

  • Otolaryngology Physician
  • Columbus, IN
  • NPI 1730440108
  Medicare reassignment Care Compare group NPD
• Onhealthcare LLC

  • Podiatrist
  • Indianapolis, IN
  • NPI 1952677353
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747267200000",
    "number": "1285808188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2345 NORTHPARK DR",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472034473",
            "telephone_number": "812-669-1490",
            "fax_number": "812-669-1491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2345 NORTHPARK DR",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472034473",
            "telephone_number": "812-669-1490",
            "fax_number": "812-669-1491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ROY",
        "middle_name": "ELLIS",
        "credential": "M.S., CCC-A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-22",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "IN",
            "license": "23002042",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "IN",
            "license": "23002042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City Optical Co., Inc.
• Gabreille Civiletto, RBT
• Brittany Nicole Clark
• Melissa Clark, 6002172
• Mollie Clark, RBT
• Shelley L Clark, NP
• Taylor Clark, RBT
• Stacey Ann Claycamp
• Clear Chiropractic Columbus, LLC
• Tracey Lynn Clifford, RPH

• Audiologist in Columbus, IN
• Providers in Columbus, IN by specialty
• Audiologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.